Acute pancreatitis is a rare but often lethal complication in post-transplant patients. We describe a case of acute pancreatitis in a male patient 11 years after renal transplantation with azathioprine for immunosuppression as possible causative agent. Laboratory and imaging diagnosis of acute pancreatitis followed by successful endoscopic interventional management using transgastric catheter drainage is presented.

A 62-year-old lady was detected to have solitary angiomyolipoma of left kidney during work up as a prospective living kidney donor. Left sided laparoscopic nephrectomy followed by bench resection of renal mass was done. The tissue was sent for frozen section and confirmed to be a benign angiomyolipoma. The kidney was transplanted and post transplant the recipient had good recovery of renal function. The recipients renal parameters remain normal a month after transplant. Donor recovery was uneventful. Final histology report of the resected mass was angiomyolipoma with no evidence of malignancy.

Background: Graft rejection that occur on the face of a fully HLA matched transplant setting have been shown to be caused by disparities in other antigenic systems viz. Minor Histocompatibility Antigens (MiHAs), endothelial antigens etc. The Non-inherited Maternal Antigens (NIMAs) similarly have been shown to offer advantage in clinical transplantation.
Aim: To investigate the role of NIMAs vis-a-vis MiHAs in renal transplantation.
Methods: We recruited 20 sibling donor–recipient pairs for the study. HLA typing was done by serology and the NIMA antigens deduced. MiHA was determined by sequence specific priming (SSP) and the degree of MiHA mismatch was analyzed in the NIMA and Non-inherited Paternal Antigens (NIPA) mismatched recipients and correlated with graft function/rejection.
Results: NIMA mismatch was observed in 6 cases, NIPA mismatch in 4 cases, 5 were HLA identical siblings and 5 were non-identical siblings. Acute rejection occurred in 2 of the 4 NIMA mismatched recipients whereas only a single recipient in the NIPA mismatched group experienced acute rejection. MiHA mismatches were observed in both the NIMA mismatched recipients who experienced rejection.
Conclusion: The observations suggest that rejection can be caused by MiHA mismatches in a setting of acceptable major HLA mismatch viz. NIMA. The observations however need to be confirmed in a larger cohort.